The Research Of Clinical Features And Prognostic Factors Of Esophageal Sarcomatoid Carcinoma

Objective: Esophageal carcinoma is one of the high incidence ofmalignancy worldwide, severely threat to human health. EsophagealCarcinoma incidence and mortality in China are located in the fifth and fourthof the various types of malignant tumors. China is one of the highestincidence of esophageal carcinoma. Squamous cell carcinoma andadencarcinoma is common in the pathological types of esophageal carcinoma,accounting for more than95%of all esophageal malignancies. Sarcomatoidcarcinoma (sarcomatoid carcinomas, SC) is a rare one of histological type ofesophageal malignancy. Sarcomatoid carcinomas of the esophagus was firstreported in1904by Hansemann, The first case of esophageal sarcomatoidcarcinoma that after surgical removal of was reported by Sutout in1949,afterward, it reported one after another, and accounted for0.36%to2.4%ofthe reports of esophageal cancer during the same period. The clinicalmanifestations, the esophageal barium meal examination, the esophagealendoscopic features of esophageal sarcomatoid carcinoma, are similar withesophageal squamous cell carcinoma and adenocarcinoma,and there is nospecific performance. However, its biological behavior, treatment modalities,and prognosis are different from squamous cell carcinoma’s andadenocarcinoma’s, because the lower degree of malignancy, and the rareincidence of lymph node metastasis and bloody transfer decide the betterprognosis. The final diagnosis relied on histopathology, but the diagnosisneeded to combine the results of microscopic morphology andimmunohistochemical results to increase diagnostic accuracy because of thelower rate of preoperative diagnosis. At present, the treatment standard has notbeen established at home and abroad for the less number of clinicalesophageal sarcomatoid carcinoma cases, the lack of large-scale randomized controlled clinical studies and the lack of sufficient knowledge of esophagealsarcomatoid carcinoma treatment. This thesis aims at a retrospective study ofesophageal sarcomatoid carcinoma for the clinical characteristics, treatmentand prognostic factors.Method: We selected28cases of esophageal sarcomatoid carcinomapatients with surgical treatment in thoracic surgery department of FourthHospital of Hebei Medical University, from January2005to December2011.All the cases included21males and7females, the proportion is3:1, they areall aged44to74years old, with a median age of60years old. The data wereanalyzed with Kaplan-Meier method, log-rank method and Cox regression forclinical characteristics and survival rate affected by different treatments onpatients by SPSS13.0statistical software, with P <0.05was consideredstatistically significant.Results:1. Survival analysis:All the28patients were followed up,16dead and12cases alive. Mediansurvival time was51months (6-90months). The postoperative survival ratesof1-year,3-year and5-year were89.3%,67.1%,38.5%.The median survival time without lymph nodes metastasis was52months,the survival rates of1-year,3-year and5-year were95.7%,84.0%,48.3%; Themedian survival time with1or2lymph nodes metastasis was24months, thesurvival rate of1-year,3-year and5-year were66.7%,0%,0%; The mediansurvival time with3to6lymph nodes metastasis was28months, and the ratewere100%,0%,0%; The median survival time with equal or more than7lymph nodes metastasis was8months, and the rate were0%,0%,0%. Amonggroups the difference was statistically significant by Log-Rank test X~2=28.462(P=0.000).The median survival time of T1stage was72months, the survival rate of1-year,3-year and5-year were100%,100%,80%; The median survival timeof T2stage was52months, the survival rate of1-year,3-year and5-year were100%,75%,37.5%; The median survival time of T3stage was30months, the survival rate of1-year,3-year and5-year were83.3%,47.6%,0%; And T4was8months,0%,0%,0%. The difference between the groups wasstatistically significant by Log-Rank test X~2=16.885(P=0.001).The median survival time of pTNM staging Ⅰwas63months, thesurvival rate of1-year,3-year and5-year were100%,100%,66.7%; Themedian survival time of pTNM staging Ⅱwas50months, the survival rate of1-year,3-year and5-year were93.3%,73.5%,33.6%; The median survivaltime of pTNM staging Ⅲ was8months, the survival rate of1-year,3-year and5-year were50%,0%,0%; The median survival time of pTNM staging Ⅳwas24months, the survival rate of1-year,3-year and5-year were100%,0%,0%;There was significant difference between the groups by Log-Rank testX~2=25.496(P=0.009).2. Kaplan-Meier univariate analysis:The results suggest that the prognosis has no significant correlation withgender, age, smoking, drinking, the site and the length of the lesions, incisionpath and treatment (surgery alone and non-surgical alone)(P>0.05). However,the number of lymph node metastasis, T stage, and pTNM staging have effecton the survival rate of patients (P <0.05).3. Multivariate analysis of the Cox risk model:The results show that the whole test of the model was statisticallysignificant, and the pTNM staging have a significant impact on the prognosisand it’s an independent prognostic factor of esophageal sarcomatoidcarcinoma. Regression coefficients of pTNM staging is2.317, standard erroris0.900, Wald statistics is6.622, P=0.010(P<0.05), the value of relative riskis10.144,95%confidence interval is1.737-59.244.4. The performance of X-ray barium meal of esophageal sarcomatoid car-cinoma:Because polyp type was more common, the esophagus sidewall can see alarge filling defect,its surface with small crater. Most of the time the tube wallis still soft. A huge mass in the cavity can be seen when the lesion is large, andthe surface of mucosal was damaged, and the tube wall was stiff for infiltration. The tube wall lesions of was fusiform expansion, but theexpansion is not obvious at the top of the tube wall. Stricture of theesophagus is generally not accompanied.5. The histopathological performance of esophageal sarcomatoid carcino-ma:Under the light microscope, esophageal sarcomatoid carcinoma generallyboth have cancer cells and sarcomatoid cells, and also have transitional zone.The stromal often consist of spindle cells which arrangement was disorganizedor wispy. The morphology of sarcomatoid organization was pleomorphic,obvious cellular atypia, and mitotic active.Conclusion:1. Esophageal sarcomatoid carcinoma is a rare malignant tumor, it haslower aggressive, lower rate of lymph node metastasis, higher five-yearsurvival rate. And lower rate of preoperative diagnosis. Surgery is thepreferred treatment.2. The factors of gender, age, smoking, drinking, the site and length ofthe tumor, incision path and treatment has no effect on the survival rate ofpatients.3. The number of lymph node metastasis, T stage, and pTNM staginghave effect on the survival rate of patients, were important prognosticindicators for esophageal sarcomatoid carcinoma．4. The pTNM staging has a significant impact on the prognosis and isindependent prognostic factors of esophageal sarcomatoid carcinoma. Morelymph node metastasis, and worse the prognosis of the patient. Therefore,early detection, early diagnosis, and comprehensive treatment can improve thelong-term survival and prognosof patients.